Introduction: Open globe trauma is caused by sharp objects (lacerations) or blunt objects (ruptures). Lacerations can be divided into three parts:  penetrating wound, intraocular foreign body  (IOFB), and perforating wounds. One of the ocular laceration trauma that needs to be aware of is the penetration of fishing hooks. There are two important aspects of injuries due to fishing hooks: intraocular foreign bodies and infections.

Case description: The patient of a 4-year-old  girl with a chief complaint left eye was exposed to a fishing hook approximately 3 hours before coming to the hospital. Ophthalmological examination was obtained visual acuity on the right eye fixes and follow the object. Examination of the anterior segment of the right eye was found corneal edema, penetrating injury due to fish hook direction at nine o'clock. The fish hook was stick on the entire thickness of the cornea. Then we also found iris trauma and opacity in the lens. The patient was diagnosed with traumatic cataracts with ocular iridolysis dextra. Initial therapy is tobroson eye drop 1 drop every 3 hours, cefadroxil syrup three times a day, and methylprednisolone 3x1/2 tablets. The patient was advised to undergo surgery.

Conclusion: Initial management should be quick and careful to aggravate the trauma. Adequate eye protection and supervision are necessary to prevent fishing hook trauma, especially children.

Introduction: A pneumothorax is a collection of air outside the lung contained within the pleural cavity. Primary spontaneous pneumothorax (PSP) and secondary spontaneous pneumothorax (SSP) are two types of spontaneous pneumothorax that differ due to the underlying illness. If the patient has a history of pulmonary disease, including tuberculosis infection, SSP may be present. Chest X-rays, chest ultrasonography, and CT scans are imaging tests that can be used to diagnose pneumothorax. We report a case of a 20-year-old man with persistent secondary spontaneous pneumothorax as a complication of tuberculosis infection.

Case description: A 20-year-old man complained of shortness of breath two weeks before being admitted to the hospital. He had a story of a TB infection. A chest X-ray and a CT scan were used to assess the patient. The pneumothorax is seen with the sign of reactive old tuberculosis. The surgeon inserted a chest tube drainage to empty the pneumothorax. However, following the assessment, the pneumothorax grew even larger than before.

Conclusion: Clinical evaluation should probably be the key determinant of the care strategy and assist with the initial diagnosis. Imaging modalities can help confirm a pneumothorax diagnosis and provide information about the extent of the pneumothorax.

Background: Incontinentia pigmenti (IP) is a rare X-linked dominant inherited genodermatosis that occurs almost in females and is usually accompanied by other ectodermal tissue diseases such as the central nervous system, eyes, hair, nails, teeth and skeletal system. This case report aims to enhance understanding of incontinentia pigmenti and provide appropriate treatment to patients and proper education to families.

Case report: A 3-days-od baby girl was consulted by the Pediatric department with complaints of blisters and erythematous rashes on almost her entire body with the Blaschko line distribution. The nails on the right and left big toes appeared inward. No history of fever and seizure. No family had similar complaints. There were no eye and nerve abnormalities involved. She treated with hydrocortisone 1% cream every 12 hours on erythematous papules and vesicles, open compresses with 0.9% NaCl every 8 hours for 10-15 minutes on lesions with yellowish crusts. Thus, the patient diagnosed with incontinentia pigmenti.

Conclusion: The diagnosis of incontinentia pigmenti is based on history and physical examination. This case is very rare, so the family needs to understand the course of this disease. Appropriate management and education can prevent secondary infection.

Introduction: Hypertension is the most common non-communicable disease, which persists as a major risk factor of cardiovascular diseases such as stroke, myocardial infection, and heart failure. Another major problem in clinical practice was the patients' adherence to treatment, directly related to the number of hypertension pills to be taken. Thus, determining the appropriate time duration and action of a hypertensive drug to maintain the blood pressure is needed. Olmesartan is one of the drug compounds frequently used for long-acting anti-hypertensive treatment. It is often combined with amlodipine; however, their combination remains unclear to provide equal efficacy and safety. Thus, in this article, we systematically summarize the combination of Olmesartan with amlodipine.

Methods: This systematic literature review was extracted from Science Direct and Pubmed to identify randomized clinical trials (RCT) of the outcome of the Olmesartan/amlodipine effect compared with other hypertension regimens by using PRISMA guideline 2009. The methodological quality of the included studies was assessed independently by two reviewers using The Cochrane Collaboration's RoB 2 tool.

Results: We evaluated twelve studies in the last ten years, and there were four studies with an intention-to-treat protocol (25% of articles had some concern, and 75% had a low risk of bias.) and eight studies with per-protocol analysis (37,5% of articles were concerned, and the rest had a low risk of overall bias). We also presented the efficacy and safety outcomes of the study reviewed.

Conclusion: Hypertension is a common non-communicable disease, and treatment approaches for hypertension vary widely. Administration of combination drugs is a good approach in reducing the dose of drug administration and reducing the incidence of side effects in monotherapy. Inhibiting the RAA system by olmesartan and reducing vascular smooth muscle tone by amlodipine gives better results and can be a safe and effective option for lowering blood pressure in hypertensive patients. The side effects observed were not severe and only observed in a few cases, making it an option to treat hypertension.

Background: Acute coronary syndrome (ACS) is a group of various clinical symptoms, including acute myocardial ischemia. When administered for coronary artery instability, one of the targets for statins is to reduce inflammation factor-like c-reactive protein (CRP). Increased levels of CRP are related to ischemic heart disease. Therefore, a meta-analysis was assessed to compare atorvastatin vs. rosuvastatin as the most effective for reducing CRP of a patient with acute coronary syndrome

Methods: We searched PubMed and Cochrane databases until October 23th 2020. Search terms included acute coronary syndrome, C-reactive protein or CRP, rosuvastatin, atorvastatin, randomized, random, and randomization. We excluded study populations with acute kidney injury/dyslipidemia/metabolic syndrome. All analyses in our study were carried out using Review Manager version 5.3 (RevMan Cochrane, London, UK).

Result: We have found four eligible studies (487 patients) were included. Funnel plots and p-Egger were inspected to assess publication bias. The pooled analysis demonstrated the benefit of atorvastatin or rosuvastatin over therapy for all studies. The result shown (WMD: 2.41; P=0.06; 95% CI: -0.07 – 4.90) on the forest plot.

Conclusion: Our meta-analysis clarifies that atorvastatin, compared to rosuvastatin, or vice versa, is not statistically significant in reducing CRP in acute coronary syndrome patients.

Non-Obstructive Azoospermia (NOA) is caused by the failure of spermatogenesis process. This case becomes the highest prevalence, 95% of the total azoospermia. Therapeutic modalities in use today such as invasive techniques, hormonal therapy, and gene therapy are less effective in the treatment of azoospermia. In addition, the overall therapeutic modalities also have serious side effects such as infection, testicular atrophy, nerve damage and other side effects. Referring to the problems above, non-obstructive azoospermia is an urgent health issue and requires effective and efficient management with minimal side effects, as the combination of Liver Growth Factor (LGF) and Adrenomedullin (ADM). LGF is able to regenerate spermatogenesis after spermatogonia testicular stem cell damage. LGF also works specifically by stimulating germinal cells without changes in somatic cells. The motility of reactivation could be improved by combining the ADM into therapy, which bind to specific receptors, and the result of increasing the cAMP / PKA and NO that are important in the regulation of cilia’s movement. Combination LGF and ADM are potential to create new therapeutic candidates in the management of non-obstructive azoospermia, which can be immediately implemented as effective and efficient therapy.

Azoospermia Non-Obstruktif (ANO) adalah azoospermia yang disebabkan kegagalan proses spermatogenesis dan merupakan kasus dengan prevalensi tertinggi (95% dari total azoospermia). Modalitas terapi yang digunakan sampai saat ini seperti teknik invasif, terapi hormonal, dan terapi gen terbukti belum efektif dalam tatalaksana azoospermia. Selain itu, keseluruhan modalitas terapi ini juga memiliki efek samping serius yang perlu diwaspadai seperti infeksi, testis atropi, kerusakan saraf, serta efek samping lainnya. Merujuk pada permasalahan diatas, azoospermia non-obstruktif merupakan masalah kesehatan yang mendesak dan membutuhkan tatalaksana yang efektif dan efisien dengan efek samping yang minimal seperti dengan kombinasi terapi LGF dan ADM. LGF mampu meregenerasi testis dan mereaktivasi spermatogenesis setelah kerusakan sel punca spermatogonia. LGF juga bekerja secara spesifik dengan menstimulasi sel-sel germinal tanpa menyebabkan perubahan pada sel-sel somatis. Motilitas sperma hasil reaktivasi spermatogenesis kemudian ditingkatkan dengan mengkombinasikan ADM kedalam terapi dimana berikatan pada reseptor-reseptor spesifik sehingga berefek pada peningkatan cAMP/PKA dan NO yang penting dalam pengaturan kibasan flagella. Perpaduan antara terapi LGF dan ADM ini sangat berpotensi menciptakan kandidat terapi baru dalam penatalaksanaan NOA yang efektif dan efisien. 

Background: One of the health fields that is currently developing in various countries in adopting information and communication technology (ICT) is e-health. Hermina Hospital has a hermina mobile application that is useful for facilitating outpatient services. Initial data collection conducted by researchers in March showed that 23% of outpatient visits from executive polyclinics were registered via this application. Therefore, the aim of this research is to analyze the usage behavior of online registration at Hermina Hospital.

Methods: This research was a quantitative correlational descriptive study with a cross sectional approach. The data used in this study obtained from the questionnaire using the method of convenient sampling with involved the participation of 110 respondents. Independent variables of this study were performance expectancy, effort expectancy, social influence, fcailitating condition dan behavioral intention. Dependent variable of this study is use behavior. The instrument used in this study was a quesioner.

Results: The results of the chi square test found that performance expectancy, usage behavior, and behavioral intention were significantly related to use behavior (p < 0.05). Based on the results of the logistic regression test, it was found that the dominant factor influencing the use behavior is behavioral intention with a value of Exp (B) or Odds Ratio (OR) 2.746 and level of significant <0.05.

Conclusion: The conclusion of this study is that there is a significant relationship between behavioral intention, effort expectancy, and performance expectancy on the decision to adopt the Hermina mobile application. 

Latar Belakang: Salah satu bidang kesehatan yang saat ini sudah berkembang di berbagai negara dalam mengadopsi teknologi informasi dan komunikasi (TIK) yaitu e-Kesehatan (e-health). Rumah Sakit Hermina memiliki aplikasi hermina mobile yang berguna untuk mempermudah pelayanan pasien rawat jalan. Penelitian ini bertujuan untuk menganalisis faktor-faktor yang mempengaruhi keputusan adopsi aplikasi pendaftaran online hermina mobile pada pasien rawat jalan poli eksekutif di Rumah Sakit Hermina Manado.

Metode: Penelitian ini merupakan penelitian kuantitatif korelasional dengan pendekatan cross sectional. Penelitian ini dilaksanakan di Rumah Sakit Hermina Manado pada November - Desember 2021. Subyek dalam penelitian ini yaitu 110 pasien poli eksekutif. Variabel bebas dari penelitian ini yaitu performance expectancy, effort expectancy, social influence, facilitating condition dan behavioral intention. Variabel terikat dari penelitian ini adalah keputusan adopsi (use behavior). Instrumen yang digunakan yaitu kuesioner. Data hasil penelitian dianalisis secara univariat, bivariat, dan multivariat. Penyajian data dibuat dalam bentuk tabel dan narasi.

Hasil: Hasil uji chi square ditemukan bahwa performance expectancy, effort expectancy, dan behavioral intention memiliki hubungan bermakna dengan keputusan adopsi (use behavior) (p<0,05). Berdasrkan hasil uji regresi logistik ditemukan faktor dominan berpengaruh terhadap keputusan adopsi pasien poli eksekutif adalah behavioral intention dengan nila Exp (B) atau Odds Ratio (OR) 2,746 dan nilai p<0,05.

Kesimpulan: Terdapat hubungan yang signifikan antara faktor behavioral intention, effort expectancy, dan performance expectancy terhadap keputusan adopsi aplikasi hermina mobile pada pasien rawat jalan poli eksekutif di Rumah Sakit Hermina Manado.

Introduction: The success of hospitals (RS) in carrying out their functions as health service institutions is characterized by good quality hospital services. Administrative employees as non-health workers must have good performance in order to realize quality health services. This study aimed to analyze the description of employee performance in the administration section of the Ratatotok Buyat Hospital in terms of aspects of work culture and work environment in the era before the Covid-19 pandemic, during the pandemic and the new normal era.

Methods: This type of research uses a qualitative descriptive method. Data collection techniques were carried out by in-depth interviews and then documented and analyzed. To obtain the validity of the data, inspection techniques were carried out through several activities, namely triangulation. Qualitative data was obtained based on the results of in-depth interviews using the Mile and Huberman data analysis model

Results: The performance of employees in the administration section shows that systems and activities related to employee work experience changes during the pandemic when there is a decrease in employee performance when compared to performance before the pandemic, in the new normal era, employee performance has increased.

Conclusion: The performance of employees in the administration of Ratatotok Buyat Hospital before the Covid-19 pandemic was very good, there was a decline in performance during the pandemic, but increased again in the new normal era.

Pendahuluan: Keberhasilan rumah sakit (RS) dalam menjalankan fungsinya sebagai lembaga pelayanan kesehatan ditandai dengan kualitas pelayanan rumah sakit yang baik. Pegawai administrasi sebagai tenaga non kesehatan harus memiliki kinerja yang baik agar dapat mewujudkan pelayanan kesehatan yang berkualitas. Penelitian ini bertujuan untuk menganalisis gambaran kinerja pegawai pada bagian administrasi Rumah Sakit Umum Pusat (RSUP) Ratatotok Buyat ditinjau dari aspek budaya kerja dan lingkungan kerja pada era sebelum pandemi Covid-19, saat pandemi dan era new normal.

Metode: Jenis penelitian ini menggunakan metode deskriptif kualitatif. Teknik pengumpulan data dilakukan dengan wawancara mendalam kemudian didokumentasikan dan dianalisis. Untuk mendapatkan keabsahan data, dilakukan teknik pemeriksaan yaitu dengan triangulasi. Data kualitatif diperoleh berdasarkan hasil wawancara mendalam dengan menggunakan model analisis data Mile dan Huberman.

Hasil: Kinerja pegawai dibagian administrasi menunjukkan bahwa saat pandemi terjadi penurunan jika dibandingkan dengan dengan kinerja sebelum pandemi, diera new normal kinerja pegawai kembali mengalami peningkatan.

Kesimpulan: Kinerja pegawai di bagian administrasi RSUP Ratatotok Buyat sebelum pandemi Covid-19 sangat baik, dan terjadi penurunan kinerja saat pandemi, namun kembali mengalami peningkatan di era new normal.

Background: Preeclampsia is a health problem because it contributes to high rates of maternal and baby morbidity and mortality. The pathogenesis of preeclampsia is still unknown, but vitamin D deficiency and low HDL-LDL serum ratio are thought to play an important role. Therefore, a study was conducted on low 25(OH)D serum level and low HDL-LDL serum ratio as risk factors for preeclampsia with severe features.

Methods: This study has a case-control design, conducted at Obstetric and Gynecology emergency room at Sanglah Hospital from January 2020 to June 2020. Subjects were 44 pregnant women, consisting 22 normal pregnant women as controls and 22 pregnant women with preeclampsia with severe features as cases, selected by purposive consecutive sampling and analyzed using SPSS 21.

Results: Preeclampsia with severe features was found 5 times higher in pregnant women with low 25(OH)D serum level than in normal pregnant women (OR = 4,91, CI 95% = 1,33-18,21, p = 0,014). Preeclampsia with severe features was found 8 times higher in pregnant women with low HDL-LDL serum ratio than in normal pregnant women (OR = 7,88, CI 95% = 1,96-31,57, p = 0,002).

Conclusion: Low 25(OH)D serum level and low HDL-LDL serum ratio are risk factors for Preeclampsia with severe features.

Pendahuluan: Preeklamsia merupakan masalah kesehatan karena berkontribusi terhadap tingginya angka morbiditas dan mortalitas ibu dan bayi. Patogenesis preeklamsia sampai saat ini masih belum diketahui secara pasti, namun kadar vitamin D dan rasio HDL–LDL serum yang rendah diduga berperan penting dalam mekanisme terjadinya preeklamsia. Penelitian kemudian dilakukan terhadap kadar 25(OH)D dan rasio HDL-LDL serum yang rendah sebagai faktor risiko terjadinya preeklamsia dengan gambaran berat.

Metode : Desain penelitian ini adalah kasus kontrol (case control) yang dilakukan di Instalasi Gawat Darurat Obstetri dan Ginekologi RSUP Sanglah, Denpasar mulai Januari 2020 sampai Juni 2020. Subyek penelitian berjumlah 44 orang ibu hamil, yang terdiri dari 22 ibu hamil normal sebagai kontrol dan 22 ibu hamil dengan preeklamsia dengan gambaran berat sebagai kasus, yang dipilih secara purposive consecutive sampling,  dan dianalisis menggunakan SPSS 21.

Hasil: Risiko terjadinya preeklamsia dengan gambaran berat  adalah 5 kali lebih tinggi pada ibu hamil dengan kadar 25(OH)D serum yang rendah dibandingkan ibu hamil normal (OR = 4,91, IK 95% = 1,33-18,21, p = 0,014). Risiko terjadinya preeklamsia dengan gambaran berat adalah 8 kali lebih tinggi pada ibu hamil dengan rasio HDL-LDL serum yang rendah dibandingkan ibu hamil normal (OR = 7,88, IK 95% = 1,96-31,57, p = 0,002).

Simpulan : Kadar 25(OH)D dan rasio HDL-LDL serum yang rendah merupakan faktor risiko preeklamsia dengan gambaran berat.

Background: Many serological examination methods have been developed to assist in diagnosing autoimmune diseases, one of which is the Chemiluminescent Immunoassay (CLIA) method. The CLIA method is an alternative method that is faster and estimated to have the same accuracy with IFA as the gold standard examination. It can help diagnose autoimmune diseases more quickly and easily. This study aims to determine the diagnostic value and conformity of the Anti-Nuclear Antibody (ANA) examination using the IFA method with the CLIA method in patients with autoimmune diseases.

Methods: The research design is a cross sectional study with consecutive sampling methods in autoimmune disease patients at Dr. Saiful Anwar Hospital Malang. ANA examination using the IFA method and the CLIA method. The data obtained by examining the IFA method is categorical, and the CLIA method is numerical. The diagnostic test uses the ROC curve and generates the AUC to determine the cut-off point. Furthermore, the suitability test was carried out using the Cohen's Kappa analysis technique. Data were analyzed using SPSS version 25 for Windows.

Results: The research sample collected was 110. Patients with positive ANA IFA results showed the same results with the CLIA method (58,18%). The diagnostic test using the cut-off value of serum ANA levels of 41.79 AU/mL showed a sensitivity value of 98.4%, specificity 95.5%, a positive predictive value of 95.63% and a negative predictive value of 98.35% with an AUC of 0.990. The suitability value of the ANA examination with the IFA and CLIA methods with the Cohen's Kappa test showed very good results, which was 0.908 (p=0.000).

Conclusion: There is a very good suitability value in examining the ANA parameters of the IFA method and the CLIA method. ANA CLIA examination has good diagnostic value.

Latar Belakang: Banyak metode pemeriksaan serologi yang berkembang untuk membantu penegakan diagnosis penyakit autoimun, salah satunya metode Chemiluminescent Immunoassay (CLIA). Metode CLIA merupakan alternatif metode yang lebih cepat dan diperkirakan memiliki keakuratan yang sama dengan pemeriksaan baku emas Immunofluorescence Assay (IFA), sehingga dapat membantu menegakkan diagnosa penyakit autoimun dengan lebih cepat dan mudah. Penelitian ini bertujuan untuk mengetahui nilai diagnostik dan kesesuaian hasil pemeriksaan Anti-Nuclear Antibody (ANA) metode IFA dengan metode CLIA pada pasien dengan penyakit autoimun.

Metode: Desain penelitian adalah studi potong lintang dengan metode consecutive sampling pada pasien penyakit autoimun di RSUD Dr. Saiful Anwar Malang. Pemeriksaan ANA menggunakan metode IFA dan metode CLIA. Data yang diperoleh dengan pemeriksaan metode IFA bersifat kategorikal, dan metode CLIA bersifat numerik. Uji diagnostik menggunakan kurva ROC dan menghasilkan AUC untuk menentukan cut-off-point. Selanjutnya dilakukan uji kesesuaian dengan teknik analisis Cohen’s Kappa. Data dianalisis dengan SPSS versi 25 untuk Windows.

Hasil: Sampel penelitian terkumpul 110. Pasien dengan hasil ANA IFA positif yang menunjukkan hasil yang sama dengan metode CLIA adalah (58,18%). Uji diagnostik menggunakan nilai cut-off kadar ANA serum 41,79 AU/mL menunjukkan nilai sensitivitas 98,4%, spesifisitas 95,5%, nilai ramal positif 95,63% dan nilai ramal negatif 98,35% dengan AUC 0,990. Nilai kesesuaian pemeriksaan ANA dengan metode IFA dan CLIA dengan uji Cohen’s Kappa menunjukkan hasil yang sangat baik secara bermakna yaitu sebesar 0,908 (p=0.000)

Kesimpulan: Terdapat nilai kesesuaian yang sangat baik pada pemeriksaan parameter ANA metode IFA dan metode CLIA. Pemeriksaan ANA CLIA memiliki nilai diagnostik yang bagus

Introduction: COVID-19 is an infectious disease caused by a new virus causes that attacks the upper respiratory tract and the lungs. The numbers of cases and deaths have increased on a daily basis on the scale of a global pandemic. Chest X-ray images have proven useful for monitoring various lung diseases and have recently been used to monitor the COVID-19 disease. Imaging modalities such as chest x-rays have the benefit of providing initial imaging before confirming with RT-PCR examination. The purpose of this study was to determine the value of the diagnostic examination of the chest x-ray compared to the RT-PCR examination which is the gold standard in diagnosing COVID-19.

Methods: This study used a diagnostic study design with a retrospective approach at Wangaya Hospital, Denpasar during the period June-November 2021. Analysis of the diagnostic test used cross tabulation and then calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and accuracy were performed.

Results: Thorax imaging diagnostic test value compared with the gold standard RT-PCR examination in form of sensitivity, specificity, PPV, NPV, LR+, LR-, and accuracy was 78%, 23%, 84%, 16.6%, 1.01, 0.95, and 69% respectively.

Conclusion: Thorax imaging provide a high sensitivity and accuracy of diagnostic in person with clinical presentation of COVID-19.

Pendahuluan: COVID-19 merupakan suatu penyakit menular yang disebabkan oleh virus baru dan menyerang saluran pernapasan bagian atas dan paru-paru. Jumlah kasus dan kematian telah meningkat setiap hari dalam skala pandemik global. Modalitas pencitraan seperti thoraks foto memiliki manfaat untuk memberikan pencitraan awal sebelum mengkonfirmasi dengan pemeriksaan RT-PCR. Tujuan penelitian ini adalah untuk mengetahui nilai pemeriksaan diagnostik yang dimiliki thoraks foto dibandingkan dengan pemeriksaan RT-PCR yang merupakan baku emas dalam mendiagnosis COVID-19.

Metode: Penelitian ini menggunakan desain studi diagnostik dengan pendekatan retrospektif di Rumah Sakit Umun Daerah Wangaya Denpasar selama periode Juni-November 2021. Analisis uji diagnostik menggunakan tabulasi silang kemudian perhitungan sensitivitas, spesitifitas, positive predictive value (PPV), negative predictive value (NPV) positive likelihood ratio (LR+), negative likelihood ratio (LR-) dan akurasi dilakukan.

Hasil: Nilai uji diagnostik thoraks foto dibandingkan dengan pemeriksaan baku emas RT-PCR berupa sensitivas, spesitifitas, PPV, NPV, LR+, LR-, dan akurasi adalah masing-masing 78%, 23%, 84%, 16.6%, 1.01, 0.95, dan 69%.

Simpulan: Thoraks foto memberikan sensitivitas dan akurasi diagnostik yang tinggi secara langsung pada presentasi klinis COVID-19.

Introduction: The mortality rate in Sanglah Hospital due to major burns is quite high. The ratio of red cell distribution width (RDW) and platelet (PLT) (RPR) as a prognostic marker of mortality in major burns has never been studied in Indonesia. Calculations of RPR are easy, widely available and cost-efficient.

Method: This study was retrospective observational case-control, with 60 patients with major burns consisting of 30 cases and 30 controls. Samples were taken from the Sanglah Hospital Medical Record Unit from April 2019 to April 2021. Cases were samples with mortality after day seven, while controls were samples that survived. RDW and PLT value on day seven are associated with the incidence of mortality.

Results: The mean of RPR in the case group was higher than in the control group. RPR mean of the control group was 0.0559, and the case group was 0.0947 (p<0.001). The increase of RPR in the case group was 40.97%. Statistical analysis showed that high RPR was a significant mortality risk factor in patients with major burns (OR = 21.36; p < 0.001).

Conclusion: High RPR is a prognostic marker of mortality in major burns at Sanglah Hospital.

Introduction: Breast cancer occurs because breast cells grow out of control. The incidence of breast cancer is still very high both in developed countries and in Indonesia. One treatment that can be done is chemotherapy. Pain is one of the effects that can occur in undergoing chemotherapy, besides the increasing stage of cancer can increase pain. This increased pain often affects a person's quality of life. This study aims to determine the relationship between pain intensity and quality of life of breast cancer patients undergoing chemotherapy at PPLK RSUD Dr. Soetomo.

Methods: This research is a descriptive analytical study with a cross-sectional method. Sampling was done by total sampling that met the inclusion and exclusion criteria, then filled out the Sf-36 questionnaire and the Wong Baker pain scale. Forty respondents with breast cancer underwent chemotherapy at PPLK RSUD Dr. Soetomo. Analysis using SPSS. The Shapiro Wilk test was used to determine the normality test. Correlation using Spearman's test.

Results: From 40 respondents, the youngest age in this study was 29 years old and the oldest was 61 years old. The highest level of pain in stage 4 breast cancer patients is in the mildly disturbing category, which is measured using the Wong Baker scale. The results of the Spearman test concluded that there were significant results between pain intensity and quality of life. There are 8 components in assessing the quality of life with the SF-36: physical function, physical role, emotional role, energy, mental health, social function, pain, and general health (p<0.05).

Conclusion: This study shows a relationship between pain intensity and quality of life of breast cancer patients undergoing chemotherapy.

Pendahuluan: Kanker payudara terjadi karena sel-sel payudara tumbuh di luar kendali. Angka kejadian kanker payudara masih sangat tinggi baik di negara maju maupun Indonesia. Salah satu pengobatan yang dapat dilakukan adalah kemoterapi. Nyeri merupakan salah satu efek yang dapat terjadi dalam menjalani kemoterapi, selain itu stadium kanker yang meningkat dapat meningkatkan rasa nyeri. Nyeri yang meningkat ini seringkali memengaruhi kualitas hidup seseorang. Penelitian ini bertujuan untuk mengetahui hubungan intensitas nyeri terhadap kualitas hidup pasien kanker payudara yang menjalani kemoterapi di PPLK RSUD Dr. Soetomo.

Metode: Penelitian ini merupakan penelitian deskripsi analitik dengan metode cross-sectional. Pengambilan sampel dilakukan dengan cara total sampling yang memenuhi kriteria inklusi dan eksklusi, kemudian dilakukan pengisian kuisioner Sf-36 dan skala nyeri Wong Baker. Terdapat 40 responden penderita kanker payudara yang menjalani kemoterapi di PPLK RSUD Dr. Soetomo. Analisis menggunakan SPSS. Uji Shapiro Wilk digunakan untuk menentukan uji normalitas. Korelasi hubungan menggunakan uji Spearman.

Hasil: Dari 40 responden diperoleh hasil dengan usia termuda dalam penelitian ini berumur 29 tahun dan tertua berumur 61 tahun. Tingkatan nyeri tertinggi pada pasien kanker payudara stadium 4 masuk dalam kategori agak mengganggu, yang diukur menggunakan skala Wong Baker. Hasil uji Spearman menyimpulkan adanya hasil yang signifikan antara intensitas nyeri dengan kualitas hidup. Terdapat 8 komponen dalam menilai kualitas hidup dengan SF-36, yaitu fungsi fisik, peranan fisik, peranan emosi, energi, kesehatan jiwa, fungsi sosial, rasa nyeri, dan kesehatan umum (p<0,05).

Kesimpulan: Penelitian ini menunjukkan adanya hubungan antara intensitas nyeri dan kualitas hidup pasien kanker payudara yang sedang menjalani kemoterapi.

Introduction: Acute myocardial infarction is coronary heart disease that causes an increase in length of stay in hospital and a high mortality rate. Reperfusion strategy is the main modality in treating ST-elevation myocardial infarction (STEMI), but a limitation in facilities and human resources in peripheral hospitals has made it impossible to do. This study aims to observe the characteristics and course of disease in patients diagnosed by STEMI without reperfusion strategy in peripheral hospitals.

Method: This study is a descriptive observational study with a cross sectional research design--retrieving research data using the total sampling method, using secondary data from medical records at Ade M Djoen Sintang Public Hospital in March - December 2021.

Results: 56 samples fulfilled inclusion and exclusion criteria, with the majority of the sample being male, the average age was 53 years. Most of the patients had the same complaint during their stay in the hospital, most of the patients were able to discharge from the hospital, and 57,14% of the patients were admitted back to the hospital with the same chief complaints after less than six months of follow-up.

Conclusion: Management of patients with STEMI without a reperfusion strategy leads to remain of chief complaints and increase of readmission within 6 months follow-up after discharge.

Latar Belakang: Infark miokard akut adalah suatu penyakit jantung koroner yang mengakibatkan peningkatan angka perawatan di rumah sakit dan angka kematian yang tinggi. Strategi reperfusi merupakan modalitas utama dalam penanganan infark miokard akut dengan elevasi segmen ST (IMA-EST), namun pada rumah sakit di perifer, keterbatasan sarana dan prasarana serta sumber daya manusia menyebabkan hal tersebut tidak memungkinkan. Tujuan penelitian ini adalah untuk mengetahui karakteristik dan perjalanan penyakit pasien yang terdiagnosis IMA-EST tanpa tatalaksana reperfusi di rumah sakit di perifer.

Metode:  Penelitian ini merupakan penelitian observasional dengan desain penelitian potong lintang. Data penelitian diambil menggunakan metode total sampling, melalui data sekunder dari rekam medis selama periode Maret - Desember 2021 di Rumah Sakit Umum Daerah (RSUD) Ade M Djoen Sintang.

Hasil: Terdapat 56 sampel yang memenuhi kriteria inklusi dan eksklusi, mayoritas sampel adalah laki-laki, rata-rata usia 53 tahun. Sebagian besar pasien mengakami keluhan yang menetap selama perawatan, sebagian besar boleh pulang dari rumah sakit. Dalam periode kurang dari 6 bulan, sebanyak 57,14% pasien masuk kembali ke rumah sakit dengan keluhan yang sama.

Simpulan: Tatalaksana pasien dengan IMA-EST tanpa strategi reperfusi menyebabkan keluhan yang menetap selama perawatan dan peningkatan pasien masuk kembali ke rumah sakit dengan keluhan yang sama setelah 6 bulan dipulangkan dari rumah sakit.

Introduction: Non-HDL cholesterol is a lipid parameter that describes the overall component of atherogenic lipids and is strongly correlated with apoB and sdLDL (small-dense LDL). There has been no study linking non HDL cholesterol (high density lipoprotein) with the degree of coronary stenosis based on the assessment of the previous syntax score. This study aims to prove the relationship between high non-HDL cholesterol and the degree of severe coronary artery lesions in patients with chronic coronary syndrome who underwent coronary angiography at Sanglah Hospital Denpasar.

Methods: This analytical observational study was conducted at Sanglah General Hospital from June to November 2020. Sampling was carried out by consecutive sampling. Non HDL cholesterol was calculated by subtracting total cholesterol with HDL and divided into 2 categories based on ROC analysis. The syntax score was calculated based on the results of coronary angiography and was divided into 2 categories (cut off 22). The relationship between non-HDL cholesterol and the degree of coronary stenosis was assessed by chi-square test analysis.

Results: Seventy-two subjects were included in this study with a mean age of 59.43±8.9 years. At the cut-off point of 104.5 mg/dL based on the ROC curve, non-HDL cholesterol had an AUC of 0.846, a sensitivity level of 80% and a specificity of 78.1% (p < 0.001). The results of bivariate analysis showed that high non-HDL cholesterol was associated with the degree of severe coronary stenosis with a prevalence ratio of 3.385 (p<0.001). Multivariate logistic regression analysis showed that high non-HDL cholesterol proved to be an independent predictor of severe coronary artery stenosis in patients with chronic coronary syndrome at Sanglah Hospital.

Conclusion: High non-HDL cholesterol was shown to be independently associated with severe coronary artery stenosis in SKK subjects at Sanglah Hospital.

Pendahuluan: Kolesterol non HDL merupakan parameter lipid yang menggambarkan keseluruhan komponen lipid atherogenik dan berkorelasi kuat dengan apoB dan sdLDL (small-dense LDL). Belum ada penelitian yang menghubungkan kolesterol non HDL (high density lipoprotein) dengan derajat stenosis koroner berdasarkan penilaian skor syntax sebelumnya. Penelitian ini bertujuan untuk membuktikan hubungan kolesterol non HDL  yang tinggi dengan derajat lesi arteri koroner yang berat pada penderita sindroma koroner kronis yang dilakukan tindakan angiografi koroner di RSUP Sanglah Denpasar.

Metode: : Penelitian observasional analitik ini dilakukan di Rumah Sakit Umum Sanglah dari Juni hingga November  2020. Pengambilan sampel dilakukan secara concecutive sampling. Kolesterol non HDL dihitung dengan cara mengurangi total kolesterol dengan HDL dan dibagi menjadi 2 kategori berdasarkan analisis ROC. Skor syntax dihitung berdasarkan hasil angiografi koroner dan dibagi menjadi 2 kategori (cut off 22). Hubungan antara kolesterol non HDL dan derajat stenosis koroner dinilai dengan analisis chi-square test.

Hasil: Tujuh puluh dua subyek dilibatkan dalam penelitian ini dengan dengan rerata usia 59,43±8,9 tahun. Pada nilai titik potong 104.5 mg/dL berdasarkan kurva ROC, kolesterol non HDL memiliki AUC 0.846, tingkat sensitifitas 80% dan spesifisitas 78,1% (p <0.001). Hasil analisis bivariat menunjukkan kolesterol non HDL yang tinggi berhubungan derajat stenosis koroner berat dengan rasio prevalens 3,385 (p<0.001). Analisis multivariat regresi logistik menunjukkan kolesterol non HDL yang tinggi terbukti sebagai prediktor independen stenosis arteri koroner berat pada penderita sindroma koroner kronis di RSUP Sanglah.

Simpulan: Kolesterol non HDL yang tinggi terbukti berhubungan secara independen dengan stenosis arteri koroner berat pada subyek SKK di RSUP Sanglah.

Introduction: Preeclampsia is the cause of 10-15% of maternal deaths in Indonesia and occurs in about 2-10% of all pregnancies worldwide. The pathogenesis that underlies the occurrence of preeclampsia is not yet clearly known so that preeclampsia is referred to as a disease of theory. Nutritional factors such as vitamin D also play a role in the development of preeclampsia. This study aims to determine the relationship between vitamin D receptor expression as a risk factor for preeclampsia with severe features.

Method: This study used a case-control design conducted in the maternity ward of Sanglah General Hospital, Denpasar from February to August 2020. A sample of 44 subjects was obtained and divided into case groups and control groups. Examination of vitamin D receptors using a central area placenta measuring 2x2 cm which was then examined semi-quantitatively at the Histology Laboratory, Faculty of Medicine, Udayana University.

Result: The results were analyzed using the chi square test. There was no significant difference in the characteristics of the two groups. There was a significant relationship between low VDR expression in the placenta and the incidence of preeclampsia with severe features (p-value 0.002; 95% CI 1.96-31.57; OR 7.88).

Conclusion: Low VDR placenta expression in pregnant women increases the risk of preeclampsia with a severe picture of 7.88 times greater than high VDR expression.

Pendahuluan: Preeklampsia menjadi penyebab 10-15% kematian maternal di Indonesia, dan terjadi pada sekitar 2-10% dari seluruh kehamilan di seluruh dunia. Patogenesis yang mendasari terjadinya preeklampsia sampai saat ini belum jelas diketahui sehingga preeklampsia disebut sebagai disease of theory. Faktor nutrisi seperti vitamin D juga memainkan peran dalam terjadinya preeklampsia. Penelitian ini bertujuan mencari hubungan ekspresi reseptor vitamin D sebagai faktor risiko terjadinya preeklamsia dengan gambaran berat.

Metode: Penelitian ini menggunakan desain kasus-kontrol yang dilakukan di Ruang Bersalin RSUP Sanglah Denpasar pada Februari sampai Agustus 2020. Didapatkan sampel sebanyak 44 subyek dan dibagi kedalam kelompok kasus dan kelompok kontrol. Pemeriksaan reseptor vitamin D menggunakan plasenta area sentral ukuran 2x2 cm yang kemudian diperiksa secara semikuantitatif di Laboratorium Histologi Fakultas Kedokteran Universitas Udayana. Hasil dianalisa menggunakan uji chi square.

Hasil: Tidak terdapat perbedaan karakteristik yang bermakna pada kedua kelompok. Terdapat hubungan yang bermakna antara ekspresi VDR pada plasenta yang rendah terhadap kejadian preeklamsia dengan gambaran berat (p-value 0.002; IK 95% 1.96-31.57; OR 7.88).

SimpulanEkspresi VDR plasenta yang rendah pada ibu hamil meningkatkan risiko terjadinya preeklamsia dengan gambaran berat sebesar 7,88 kali lebih besar dibandingkan ekspresi VDR tinggi.

Introduction: Ovarian cancer is cancer of the female reproductive organs with the highest mortality and is in the third position of female cancer after mammary and cervical cancer. The mortality rate and survival rate of ovarian cancer is mainly determined by the stage at which ovarian cancer is diagnosed. Until now there is no method for early detection of ovarian cancer with good sensitivity and specificity. Assessment of different neoplasias in the adnexa (ADNEX) is a model proposed by international ovarian tumor analysis (IOTA) to help distinguish benign or malignant adnexa tumors.

Methods: This study is a observational clinical test to find out the accuracy of ADNEX model to predict ovarian malignancy conducted at the Obstetric and Gynecology Outpatient Ward in Sanglah hospital, Denpasar from November 2019 to April 2020. Consecutive sampling was done and 88 sample was recruited with a diagnosis of ovarian tumors. Then the research sample was sent to the Pathology Anatomy laboratory of Sanglah Hospital for histopathological examination. This result would then be compared to the prediction results of the ADNEX model.

Results: 35 samples of benign ovarian tumors and 53 samples of ovarian cancer were found with the ADNEX method. There were 46 samples with malignant tumor both by the ADNEX model and histopathology results, 7 samples of malignant tumor at histopathology result but benign by the ADNEX model, 6 samples of benign tumor according to histopathology but malignant using the ADNEX model, and 29 samples of benign tumor according to histopathology and the ADNEX model. Using cut off of 49,6%, the study reported a sensitivity level of 86.8%, specificity 82.6%, positive predictive value 88.5%, negative predictive value 80.6%, and 85.2% accuracy.

Conclusion: The ADNEX model has a high level of specificity, sensitivity and diagnostic accuracy in diagnosing ovarian cancer and can be used in combination with other clinical markers for early detection of malignancy in ovarian tumors.

Pendahuluan: Kanker ovarium merupakan salah satu jenis kanker organ reproduksi wanita dengan mortalitas tertinggi dan berada pada posisi ke-tiga kanker perempuan setelah kanker mammae dan serviks. Angka mortalitas dan survival rate kanker ovarium sangat ditentukan oleh stadium saat kanker ovarium terdiagnosis. Hingga saat ini belum tersedia metode pemeriksaan untuk deteksi dini kanker ovarium dengan sensitivitas dan spesifisitas yang memadai. Assessment of different neoplasias in the adnexa (ADNEX) adalah model yang diajukan oleh International Ovarian Tumor Analysis (IOTA) untuk membantu membedakan tumor adnexa sebagai tumor jinak atau ganas.

Metode: Penelitian ini merupakan penelitian observasional uji klinik untuk mengetahui akurasi model ADNEX untuk memprediksi keganasan ovarium yang dilakukan di Poliklinik Kebidanan dan Penyakit Kandungan RSUP Sanglah, Denpasar pada bulan November 2019 hingga April 2020. Sampling dilakukan secara consecutive dan didapatkan 88 orang dengan diagnosis tumor ovarium. Sampel penelitian dikirimkan ke laboratorium Patologi Anatomi RSUP Sanglah dan dilakukan pemeriksaan histopatologi untuk kemudian dibandingkan dengan hasil prediksi dari model ADNEX.

Hasil: Dalam penelitian ini didapatkan 35 sampel dengan tumor jinak ovarium dan 53 sampel dengan kanker ovarium dengan menggunakan metode ADNEX. Terdapat 46 sampel dengan hasil pemeriksaan model ADNEX ganas dan hasil pemeriksaan histopatologi ganas, 7 sampel histologi ganas namun model ADNEX jinak, 6 sampel histopatologi jinak namun model ADNEX ganas, dan 29 sampel histopatologi jinak dan model ADNEX jinak. Hasil penelitian memperlihatkan tingkat sensitifitas 86,8%, spesifisitas 82,6%, nilai prediksi positif 88,5%, nilai prediksi negatif 80,6%, dan akurasi 85,2%.

Simpulan: Model ADNEX memiliki tingkat spesifisitas, sensitivitas dan akurasi diagnostik yang tinggi dalam mendiagnosis kanker ovarium dan dapat digunakan bersama dengan penanda klinis lain untuk deteksi dini keganasan pada tumor ovarium.